Provider Demographics
NPI:1255541934
Name:BAWA DENTISTRY PLLC
Entity type:Organization
Organization Name:BAWA DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOOP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-266-0111
Mailing Address - Street 1:14631 LEE HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5824
Mailing Address - Country:US
Mailing Address - Phone:703-266-0111
Mailing Address - Fax:
Practice Address - Street 1:14631 LEE HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5824
Practice Address - Country:US
Practice Address - Phone:703-266-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412382122300000X
VA0401412401122300000X
CA466861223G0001X
CA508461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty